A single injection of pembrolizumab costs 5000 euros, and therefore remains inaccessible for most patients. In Cagnes-sur-mer, a doctor fights to save one of his patients.
In Cagnes-sur-mer, a doctor fights to save one of his patients suffering from bladder cancer. Only pembrolizumab, an immunotherapy, could overcome it. Problem: a single injection of the treatment costs 5000 euros, without being reimbursed by social security.
“A single patient can strain the hospital budget”
“For Mr. René Esteve, I have no other possible solutions because he has another pathology which means that I cannot use chemo otherwise I put him in danger”, explains to France Info Doctor Jérôme Barrière, oncologist at the Saint Jean clinic. “No establishment can afford to pay for a drug that is not reimbursed. As it is expensive, a single patient can strain the hospital budget,” he laments.
René Esteve, 76, has been fighting the disease for three years, and has not received any treatment for two months, for lack of means. However, the Haute Autorité de Santé is in favor of the management of pembrolizumab. “The pivotal study KEYNOTE-045 estimated the average lifespan at 1.57 years in patients treated with pembrolizumab versus 0.94 years in those treated with chemotherapy, i.e. an average gain of approximately +7.6 months per patient The average gain in quality-adjusted survival was estimated at 4.8 months per patient compared to chemotherapy The 5-year survival rate was estimated at 16% with pembrolizumab and 1.7% with chemotherapy”, she notes in a report.
Administrative problems
The MSD laboratory, which markets pembrolizumab, evokes administrative problems: “a price agreement has been signed between MSD and the authorities (…) but for administrative reasons, the financing (…) in this indication does not is still not published”. In France, the incidence of bladder cancer is low. Incidence and mortality projections updated in 2018 estimate 13,338 new cases, including 5,013 deaths.
Urothelial carcinoma is the most common bladder cancer; over 95% of cases are tobacco-related. For the most severe forms, called “infiltrative”, cisplatin-based chemotherapy is part of standard management. But this molecule cannot be administered to all patients, especially the oldest.
“Patients often have additional problems related to tobacco, cardiovascular or pulmonary, and are therefore weakened”, explains Olivier Mir, oncologist at the Gustave Roussy Institute in Villejuif. “The administration of cisplatin also requires good renal function, but this declines with age.“, he adds. In the end, almost half of the patients would be ineligible for cisplatin, and therefore potentially benefit from pembrolizumab.
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